Exploration of Surgical Treatment for Chronic Anorectal Pain Based on Digital Examination and MRI findings

2021 ◽  
Keyword(s):  
Surgical Treatment ◽  
Digital Examination ◽  
Mri Findings ◽  
Anorectal Pain

scholarly journals Patient-reported outcomes after surgical and non-surgical treatment of proximal hamstring avulsions in middle-aged patients

2019 ◽  
Vol 5 (1) ◽  
pp. e000511 ◽  
Author(s):  
Elsa Pihl ◽  
Olof Skoldenberg ◽  
Hans Nasell ◽  
Sven Jonhagen ◽  
Paula Kelly Pettersson ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Treatment Algorithm ◽  
Hamstring Injury ◽  
Middle Aged ◽  
Mri Findings ◽  
Aged Patients ◽  
Patient Reported ◽  
Proximal Hamstring ◽  
Non Surgical Treatment

ObjectivesIn the literature on proximal hamstring avulsions, only two studies report the outcomes of non-surgically treated patients. Our objective was to compare subjective recovery after surgical and non-surgical treatment of proximal hamstring avulsions in a middle-aged cohort.MethodsWe included 47 patients (33 surgically and 14 non-surgically treated) with a mean (SD) age of 51 (±9) years in a retrospective cohort study. Follow-up time mean (SD) of 3.9 (±1.4) years. The outcome variables were the Lower Extremity Functional Scale (LEFS) and questions from the Proximal Hamstring Injury Questionnaire. Outcome variables were adjusted in regression models for gender, age, American Society of Anestesiologits (ASA) classification and MRI findings at diagnosis.ResultsThe baseline characteristics showed no differences except for the MRI result, in which the surgically treated group had a larger proportion of tendons retracted ≥ 2 cm. The mean LEFS score was 74 (SD±12) in the surgically treated cohort and 72 (SD±16) in the non-surgically treated cohort. This was also true after adjusting for confounders. The only difference in outcome at follow-up was the total hours performing physical activity per week, p=0.02; surgically treated patients reported 2.5 hours or more (5.2 vs 2.7).ConclusionThis study on middle-aged patients with proximal hamstring avulsions was unable to identify any difference in patient-reported outcome measures between surgically and non-surgically treated patients. The vast majority of patients treated surgically had complete proximal hamstring avulsions with ≥ 2 cm of retraction. We conclude that to obtain an evidence-based treatment algorithm for proximal hamstring avulsions studies of higher scientific level are needed.

Postoperative Imaging after Impingement Surgery

2017 ◽  
Vol 21 (05) ◽  
pp. 529-538 ◽  
Author(s):  
Karl Grob ◽  
Chan-Hi Kim ◽  
Tobias Dietrich
Keyword(s):  
Surgical Treatment ◽  
Revision Surgery ◽  
Rare Complication ◽  
Current Evidence ◽  
Cartilage Defects ◽  
Loose Bodies ◽  
Mri Findings ◽  
Postoperative Imaging ◽  
Labral Tears ◽  
Magnetic Resonance Imaging Mri

AbstractIn addition to the patient's medical history and clinical evaluation, conventional radiographs and magnetic resonance imaging (MRI) are important tools to indicate appropriate conservative treatment or even revision surgery in patients with symptoms after surgical management of femoroacetabular impingement (FAI). We present an overview of current evidence in postoperative imaging after impingement surgery. Undercorrection of the underlying osseous FAI configuration is the most frequent indication for revision surgery within the first 2 years after index FAI surgery. Femoral neck fractures, iatrogenic chondral injuries, early conversion to total hip arthroplasty, loose bodies, and heterotopic ossifications are rare but typical early complications after surgical treatment of FAI. Abnormal MRI findings after FAI surgery such as intra-articular adhesions, labral tears, cartilage defects, and anterior capsular defects are common findings in both asymptomatic and symptomatic postoperative patients. Avascular necrosis of the femoral head is an extremely rare complication after surgical treatment of FAI.

To scan or not to scan: An evaluation of preoperative MRI use in primary breast cancer assessments.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e14146-e14146
Author(s):  
Tesia McKenzie ◽  
Davina Matinho ◽  
Olivia Scott ◽  
Arbaz Khan ◽  
Mila Lachica ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Surgical Treatment ◽  
False Positive ◽  
Primary Breast Cancer ◽  
True Positive ◽  
Newly Diagnosed ◽  
Mri Findings ◽  
Positive Rate ◽  
The Impact

e14146 Background: Breast cancer (BC) is the most common invasive cancer in adult females.The role of preoperative MRI in assessing the extent of primary breast cancer remains controversial. This study’s objective is to determine if MRIs performed after the diagnosis of invasive/non-invasive-breast cancer will identify additional breast cancers. We hypothesize that preoperative MRIs will result in the discovery of additional significant lesions, leading to changes in surgical treatment. Methods: A retrospective study of 389 BC patient charts were reviewed, dated from January 2000- July 2019. Files were collected from an office in the Breast Cancer Surgery Department. Information on each patient’s imaging studies, treatment, demographics, surgery, and pathology were collected and stored in anonline cloud system. Summary statistics, including proportions, percentages, and difference of proportion hypothesis tests were utilized to interpret the data. All statistical tests were conducted at a 95% confidence interval. Results: We reviewed the charts of 335 patients that met eligibility criteria. In 221 newly diagnosed cancers, a preoperative MRI was taken before treatment. 127 cancers (57.5%)showed additional finding.In BC patients with additional preoperative MRI findings, we observed 61.4%true positive and 38.6%false positive results. These values are comparable to prior studies.We determined that the treatment plan was altered in 17.6%of all patients who received an MRI and in 30.7%of patients with a true positive MRI finding, which is also consistent with previous literature.A majority of the treatment changes were from Lumpectomy to Mastectomy. Conclusions: Literature on MRI use in BC diagnosis exists; our study differs by focusing on newly diagnosed breast cancers.We discovered 35.3% of preoperative MRIs identified a true additional finding in known breast cancer. In addition, our true positive rate (61.4%) and false positive rate (22.2%) of MRI findings is comparable to those of previous studies. Plans were changed in 30.7% of additional findings supporting the idea that preoperative MRI studies are useful when organizing surgical treatment. Further studies to demonstrate the impact on local recurrence rates and overall survival, may clarify the true role of pre-operative MRI in these cases.

Aneurysm of the inferior vena cava: case report and review of the literature

2008 ◽  
Vol 23 (4) ◽  
pp. 184-188 ◽  
Author(s):  
L Davidovic ◽  
M Dragas ◽  
V Bozic ◽  
Đ Takac
Keyword(s):  
Case Report ◽  
Surgical Treatment ◽  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Vena Cava ◽  
Low Risk ◽  
Review Of The Literature ◽  
Mri Findings ◽  
Retroperitoneal Tumour ◽  
Ct And Mri

Aneurysms of the inferior vena cava (IVC) are extremely rare. To the best of our knowledge, only 29 cases of IVC aneurysms are published in literature. We present a new case of surgically treated symptomatic saccular aneurysm of the infrarenal IVC and review previously published cases. Following resection of the aneurysm and the thrombosed infrarenal IVC, the patient fully recovered. Thrombosed IVC aneurysm may mimic a retroperitoneal tumour. In some cases, CT and MRI findings may be equivocal. Surgical treatment is indicated in all symptomatic and low-risk asymptomatic cases.

scholarly journals Elastofibroma dorsi: evaluating the sufficiency of magnetic resonance in diagnosis and the time of surgical treatment

2019 ◽  
Vol 6 (2) ◽  
pp. 388
Author(s):  
Devrim Ozer ◽  
Yavuz Arikan ◽  
Cantay Gok
Keyword(s):  
Surgical Treatment ◽  
Magnetic Resonance ◽  
Clinical Symptoms ◽  
Axial Plane ◽  
Mri Findings ◽  
Elastofibroma Dorsi ◽  
Experienced Radiologist ◽  
Mean Diameter ◽  
The Masses

Background: Elastofibroma dorsi is a rarely seen fibroelastic pseudotumor. While radiological evaluation can be best done with magnetic resonance imaging (MRI), biopsy may be additionally required in diagnosis. Surgical excision of the tumor is recommended in painful cases, however, many cases can be treated and followed with conservative methods. In our study, we evaluated the features and sufficiency of MRI in diagnosis, the growth extent of the masses and the need for surgical treatment.Methods: Eight lesions of the five patients diagnosed and followed up in our clinic between the years 2014 and 2017 were included in the study. All patients were female and had a mean age of 60.4 (50-68). Lesions were bilaterally located in three patients. Seven lesions were diagnosed with MRI and one was diagnosed with biopsy. The size of the lesions at the time of diagnosis and final follow-up and differences in the radiological features were evaluated by the same experienced radiologist using MRI. Complaints of the patients were evaluated, and their clinical examinations were performed.Results: The mean period of follow-up was 22.4 (8-42) months. The masses had a mean diameter of 59.5 (40-75)mm in the craniocaudal plane and 59.4 (40-70) x 22.4 (10-36)mm in the axial plane at the time of diagnosis and a mean diameter of 60.5 (40-75)mm in the craniocaudal plane and 61 (43-70) x 22.6 (10-36)mm in the axial plane at the final follow-up. At the final follow-up, two patients had three lesions without pain and three patients had five lesions with mild pain. No movement limitation was observed.Conclusions: Typical MRI findings were observed in all lesions (including the one that was performed biopsy) and biopsy was not planned for the lesions with typical findings. All lesions were followed by conservative management and no discontent was reported by the patients. Surgical treatment was planned in case of severe pain, rapid growth and advanced clinical symptoms. 

scholarly journals MRI-derived neurovascular compression score provides the indication of surgical treatment of patients with primary trigeminal neuralgia: A validated multi-center study

2020 ◽  
Author(s):  
Jian Shen ◽  
Wenli Zhou ◽  
Weiqiang Shen ◽  
Huimei Zhang ◽  
Xianfang Hu ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Scoring System ◽  
Diagnostic Performance ◽  
False Positive Rate ◽  
Radiological Finding ◽  
Neurovascular Compression ◽  
Mri Findings ◽  
Tof Mra

Abstract Background The radiological assessment of neurovascular compression (NVC) is various regarding MRI techniques and assessing methods in patients with trigeminal neuralgia (TN), and the false-positive rate of MRI findings is not low. Better MRI techniques with the NVC assessing method are warranted to be determined. This study aims to investigate the diagnostic performance of 3D TOF MRA and 3D Fast Imaging Employing Steady-state Acquisition (FIESTA) with a novel NVC scoring system in TN patients. Methods Patients with confirmed TN who underwent MRI studies before microvascular decompression (MVD) were retrospectively included into the study. A new NVC scoring system based on the contact relationship of the trigeminal nerve and the vessel was performed to assess the NVC in the symptomatic and contralateral asymptomatic side. The radiological finding was correlated with the intraoperative result to figure out the diagnostic accuracy of MRI techniques. Besides, the comparison of both sides was performed to determine the radiological indicator of MVD. Results Seventy-three TN patients were recruited, and 146 trigeminal nerve sides were analyzed. For the symptomatic sides, 69 patients had surgically confirmed offending vessels, most of which was SCA, and the positive NVC rate was 95.5%. For the contralateral side, 33 patients have been found with NVC on MRI. The NVC score of the symptomatic side was significantly higher than that of asymptomatic sides (6.7 vs. 1.6; p < 0.001). The optimal cut-off value in predicting trigeminal neuralgia was found as NVC > 4 with sensitivity and specificity of 82.2% and 98.6%, respectively. Conclusion 3D-TOF MRA and FIESTA enable a good diagnostic performance of NVC, and NVC score > 4 was identified to predict trigeminal neuralgia, suggestive of subsequent surgical treatment. Trial registration: The study has been retrospectively registered at the local ethical Institution Review Board (IRB) of Huzhou Central Hospital and Sir Run Run Shaw Hospital with the IRB number (20181108-01; Huzhou) and (20200423-43; SRRSH).

scholarly journals Neurovascular Compression in Arterial Hypertension: Correlation of Clinical Data to 3D-Visualizations of MRI-Findings

2021 ◽  
Vol 14 (1) ◽  
pp. 16-27
Author(s):  
Panagiota Manava ◽  
Peter Hastreiter ◽  
Roland E. Schmieder ◽  
Susanne Jung ◽  
Rudolf Fahlbusch ◽  
...  
Keyword(s):  
Image Processing ◽  
Surgical Treatment ◽  
Arterial Hypertension ◽  
Clinical Data ◽  
Microvascular Decompression ◽  
Selection Criteria ◽  
Neurovascular Compression ◽  
Hemodynamic Parameters ◽  
Treatment Resistant ◽  
Mri Findings

Aims: In this study, we attempted to identify clinical parameters predicting the absence or presence of Neurovascular Compression (NVC) at the Ventrolateral Medulla (VLM) in arterial hypertension (HTN) in MRI findings. Background: Cardiovascular and pulmonary afferences are transmitted through the left vagus and glossopharyngeal nerve to the brain stem and vasoactive centers. Evidence supports the association between HTN and NVC at the left VLM. Several independent studies indicate a reduction of HTN after Microvascular Decompression (MVD) of the left. Several independent studies indicate a reduction of HTN after Microvascular Decompression (MVD) of the left VLM. Image processing of MRI provides comprehensible detection of NVC. HTN affects hemodynamic parameters and organs. Objective: This study analyzes and correlates clinical data and MRI findings in patients with and without NVC at the VLM in treatment resistant HTN to obtain possible selection criteria for neurogenic hypertension. Methods: In 44 patients with treatment resistant HTN, we compared MRI findings of neurovascular imaging to demographic, clinical and lifestyle data, office and 24-hour ambulatory Blood Pressure (BP), and cardiovascular imaging and parameters. Results: Twenty-nine (66%) patients had evidence of NVC at the VLM in MRI. Sixteen patients (36%) had unilateral NVC on the left side, 7 (16%) unilateral right and 6 (14%) bilateral NVC. Fifteen (34%) had no evidence of NVC at the VLM. Patients with left sided NVC were significantly younger, than those without NVC (p=0.034). They showed a statistically significant variance in daytime (p=0.020) and nighttime diastolic BP (p<0.001) as the mean arterial pressure (p=0.020). Other measured parameters did not show significant differences between the two groups. Conclusion: We suggest to examine young adults with treatment resistant HTN for the presence of NVC at VLM, before signs of permanent organ damage appear. Clinical and hemodynamic parameters did not emerge as selection criteria to predict NVC. MVD as a surgical treatment of NVC in HTN is not routine yet as a surgical treatment of NVC in HTN is not routine yet. Detection of NVC by imaging and image processing remains the only criteria to suggest MVD, which should be indicated on an individual decision.

Use of microscope-integrated near-infrared indocyanine green videoangiography in the surgical treatment of intramedullary cavernous malformations: report of 8 cases

2013 ◽  
Vol 18 (5) ◽  
pp. 443-449 ◽  
Author(s):  
Toshiki Endo ◽  
Misaki Aizawa-Kohama ◽  
Kenichi Nagamatsu ◽  
Kensuke Murakami ◽  
Akira Takahashi ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Indocyanine Green ◽  
Near Infrared ◽  
Complete Removal ◽  
Clinical History ◽  
Mri Findings ◽  
Indocyanine Green Videoangiography ◽  
Cavernous Malformations ◽  
Venous Anomalies ◽  
Venous Structure

Object The characteristics and efficacy of indocyanine green (ICG) videoangiography in cavernous malformation (CM) have not been fully elucidated. The purpose of this paper is to examine the potential utility of ICG videoangiography in the surgical treatment of intramedullary CMs. Methods The authors conducted a retrospective review of 8 cases involving 5 men and 3 women who had undergone surgery for intramedullary CM between January 2008 and July 2011. All patients were evaluated by means of MRI. The MRI findings and clinical history in all cases suggested intramedullary CM as a preoperative diagnosis. In 2 of 8 cases, dilated venous structures associated with CMs were demonstrated. In one of these cases, there were coexisting extramedullary CMs. Intraoperatively, ICG fluorescence was observed for 5 minutes using microscope-integrated videoangiography. Results In all 8 cases, intra- and extramedullary CMs were seen as avascular areas on ICG videoangiography. Indocyanine green videoangiography helped surgeons to localize and predict margins of the lesions before performing myelotomy. Importantly, in the cases with associated venous anomalies, ICG videoangiography was useful in delineating and preserving the venous structures. In extramedullary CMs located dorsal to the spinal cord, gradual ICG infiltration was seen, starting at 110 seconds and maximal at 210 seconds after injection. Postoperative MRI confirmed total removal of the lesions in all cases, and subsequent recovery of all patients was uneventful. Conclusions Indocyanine green videoangiography provided useful information with regard to the detection of lesion margins by demonstrating intramedullary CMs as avascular areas. In cases associated with venous anomalies, ICG contributed to safe and complete removal of the CMs by visualizing the venous structure. In extramedullary CMs, ICG videoangiography demonstrated the characteristic of slow blood flow within CMs.

scholarly journals Chronic and Recurrent Rectus Femoris Central Tendon Ruptures in Athletes: Clinical Picture, MRI Findings, and Results of Surgical Treatment

2021 ◽  
Vol 9 (2) ◽  
pp. 232596712098448
Author(s):  
Lasse Lempainen ◽  
Jussi Kosola ◽  
Xavier Valle ◽  
Jordi Puigdellivol ◽  
Juha Ranne ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Clinical Picture ◽  
Tendon Rupture ◽  
Case Series ◽  
Rectus Femoris ◽  
Tendon Injuries ◽  
Return To Play ◽  
Return To Sports ◽  
Mri Findings ◽  
Mri Scans

Background: Severe rectus femoris central tendon rupture is an uncommon sports-related injury. Most rectus femoris central tendon injuries can be treated by nonoperative means, but some tend to reinjure, resulting in chronic symptoms. Physicians treating athletes with rectus femoris injuries should be aware of this clinical condition and know that surgical treatment could be beneficial to the athlete if the rectus femoris central tendon rupture becomes chronic. Purpose: To describe the clinical picture, magnetic resonance imaging (MRI) findings, and surgical treatment results of rectus femoris central tendon injuries. Study Design: Case series; Level of evidence, 4. Methods: This study included 12 patients who underwent successful repair of recurrent rectus femoris central tendon rupture. Presurgical MRI scans were obtained and compared with the surgical findings. The time of return to play was recorded, and the outcome of surgical treatment was evaluated with validated Subjective Patient Outcome for Return to Sports (SPORTS) criteria: good = full return to preinjury level of sports without any symptoms; moderate = return to preinjury level of sports with some residual symptoms (mild discomfort during sports); and poor = did not return to preinjury level of sports. Results: Overall, 10 patients had a good outcome (83%), and 2 had a moderate outcome (17%). All athletes included in the study were able to return to sport at their preinjury levels 2.5 to 4 months postoperatively. Presurgical MRI scans correlated well with the surgical findings. Conclusion: The surgical treatment of rectus femoris central tendon rupture seems to be a good option in chronic and recurrent cases. After surgery and successful rehabilitation, the athlete is expected to continue sports at the preinjury level.

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